401k Plan data: NORTHERN MAINE GENERAL DENTAL BENEFITS PLAN plan

NORTHERN MAINE GENERAL DENTAL BENEFITS PLAN 401k Plan overview

Plan Name	NORTHERN MAINE GENERAL DENTAL BENEFITS PLAN
Plan identification number	502

NORTHERN MAINE GENERAL DENTAL BENEFITS PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Dental

401k Sponsoring company profile

Northern Maine General has sponsored the creation of one or more 401k plans.

Company Name: Northern Maine General

Employer identification number (EIN): 010262323

NAIC Classification: 623000
NAIC Description: Nursing and Residential Care Facilities

Additional information about Northern Maine General

Jurisdiction of Incorporation: Maine Bureau of Corporations, Elections & Commissions

Incorporation Date:

Company Identification Number: 19070015ND

More information about Northern Maine General

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NORTHERN MAINE GENERAL DENTAL BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2020-01-01
502 2019-01-01 MICHELLE RAYMOND 2020-07-30
502 2018-01-01 MICHELLE RAYMOND 2020-08-04
502 2017-01-01 MICHELLE RAYMOND 2020-08-04
502 2016-01-01
502 2016-01-01 MICHELLE RAYMOND 2020-08-04
502 2015-01-01 MICHELLE RAYMOND 2020-08-04

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
502	2020-01-01
502	2019-01-01	MICHELLE RAYMOND	2020-07-30
502	2018-01-01	MICHELLE RAYMOND	2020-08-04
502	2017-01-01	MICHELLE RAYMOND	2020-08-04
502	2016-01-01
502	2016-01-01	MICHELLE RAYMOND	2020-08-04
502	2015-01-01	MICHELLE RAYMOND	2020-08-04

Plan Statistics for NORTHERN MAINE GENERAL DENTAL BENEFITS PLAN

401k plan membership statisitcs for NORTHERN MAINE GENERAL DENTAL BENEFITS PLAN

Measure Date Value
2020: NORTHERN MAINE GENERAL DENTAL BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 104
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 107
Total of all active and inactive participants 2020-01-01 107
Total participants 2020-01-01 107
2019: NORTHERN MAINE GENERAL DENTAL BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 112
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 104
Total of all active and inactive participants 2019-01-01 104
2018: NORTHERN MAINE GENERAL DENTAL BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 125
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 112
Total of all active and inactive participants 2018-01-01 112
2017: NORTHERN MAINE GENERAL DENTAL BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 129
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 125
Total of all active and inactive participants 2017-01-01 125
2016: NORTHERN MAINE GENERAL DENTAL BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 144
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 129
Total of all active and inactive participants 2016-01-01 129
Total participants 2016-01-01 129
2015: NORTHERN MAINE GENERAL DENTAL BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 144
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 144
Total of all active and inactive participants 2015-01-01 144

Measure	Date	Value
2020: NORTHERN MAINE GENERAL DENTAL BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	104
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	107
Total of all active and inactive participants	2020-01-01	107
Total participants	2020-01-01	107
2019: NORTHERN MAINE GENERAL DENTAL BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	112
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	104
Total of all active and inactive participants	2019-01-01	104
2018: NORTHERN MAINE GENERAL DENTAL BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	125
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	112
Total of all active and inactive participants	2018-01-01	112
2017: NORTHERN MAINE GENERAL DENTAL BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	129
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	125
Total of all active and inactive participants	2017-01-01	125
2016: NORTHERN MAINE GENERAL DENTAL BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	144
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	129
Total of all active and inactive participants	2016-01-01	129
Total participants	2016-01-01	129
2015: NORTHERN MAINE GENERAL DENTAL BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	144
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	144
Total of all active and inactive participants	2015-01-01	144

Form 5500 Responses for NORTHERN MAINE GENERAL DENTAL BENEFITS PLAN

2020: NORTHERN MAINE GENERAL DENTAL BENEFITS PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: NORTHERN MAINE GENERAL DENTAL BENEFITS PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: NORTHERN MAINE GENERAL DENTAL BENEFITS PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: NORTHERN MAINE GENERAL DENTAL BENEFITS PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: NORTHERN MAINE GENERAL DENTAL BENEFITS PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: NORTHERN MAINE GENERAL DENTAL BENEFITS PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	First time form 5500 has been submitted	Yes
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

ANTHEM HEALTH PLANS OF MAINE (National Association of Insurance Commissioners NAIC id number: 52618 )

Policy contract number

061970

Policy instance

Insurance contract or identification number	061970
Number of Individuals Covered	107
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,548
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $31,259
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,548
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

ANTHEM HEALTH PLANS OF MAINE, INC. (National Association of Insurance Commissioners NAIC id number: 52618 )

Policy contract number

061970

Policy instance

Insurance contract or identification number	061970
Number of Individuals Covered	104
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,954
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $32,799
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,954
Insurance broker organization code?	3

ANTHEM HEALTH PLANS OF MAINE, INC. (National Association of Insurance Commissioners NAIC id number: 52618 )

Policy contract number

061970

Policy instance

Insurance contract or identification number	061970
Number of Individuals Covered	112
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $2,051
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $35,787
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,051
Insurance broker organization code?	3

ANTHEM HEALTH PLANS OF MAINE, INC. (National Association of Insurance Commissioners NAIC id number: 52618 )

Policy contract number

061970

Policy instance

Insurance contract or identification number	061970
Number of Individuals Covered	125
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2,199
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $40,697
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ANTHEM HEALTH PLANS OF MAINE, INC. (National Association of Insurance Commissioners NAIC id number: 52618 )

Policy contract number

061970

Policy instance

Insurance contract or identification number	061970
Number of Individuals Covered	144
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,488
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $48,792
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,488
Insurance broker organization code?	3

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Company Name:	Northern Maine General
Employer identification number (EIN):	010262323
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities

Jurisdiction of Incorporation:	Maine Bureau of Corporations, Elections & Commissions
Incorporation Date:
Company Identification Number:	19070015ND